Collecting Branch : EPS1 Servicing Branch : LIC of India, Vallioor Br Office

65/A Main Road

Transaction No : 11174731
Vallioor.,Dist-Tiraneveli (Tn)
Date ( Time ): 28/08/2019 ( 18:48:36 ) Vallioor,627117
bo_eps1@licindia.com
Receipt No : PR1117473100011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 10,200.65 through Payment Gateway over the Internet from:

Smt./Ms./Shri : G Honest Raj

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
308765795 814 9,710.00 1 9,710.00 130.00 74G
G Honest Raj 16 HLY 06/19 230.65 130.0 12/19
0077374G 12/06/2018 3,00,000 06/19 0.00 10,200.65 0

Page Total (`) 9,710.00 9,710.00 130.00

230.65 130.00
0.00 10,200.65
Grand Total (`) 9,710.00 9,710.00 130.00
230.65 130.00
0.00 10,200.65

TEN THOUSAND TWO HUNDRED RUPEES AND SIXTY FIVE PAISE ONLY

G Honest Raj
Consolidated Stamp Duty Paid
S/O Ganapathy
Santhi Kovil Street, CSD/328/2019/646/19 DTD.15/02/2019
Avaraikulam Po , Radhapuram T.

627133 Payment Acknowledgement generated through

Online Portal on 28-Aug-19 Time : 18:52:36.
Mobile: 9445202391
Email: honuraj06@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!